Journal
JOURNAL OF VIRAL HEPATITIS
Volume 21, Issue 12, Pages 930-937Publisher
WILEY
DOI: 10.1111/jvh.12224
Keywords
APRI; chronic hepatitis; comparative effectiveness; FIB-4; liver stage prediction; serum markers of fibrosis
Funding
- AbbVie Pharmaceuticals
- Bristol-Myers Squibb
- Gilead Pharmaceuticals
- GlaxoSmithKline
- Intercept Pharmaceuticals
- Merck
- Vertex Pharmaceuticals
- CDC Foundation
- AbbVie
- Genentech, a Member of the Roche Group
- Janssen Pharmaceutical Companies of Johnson Johnson
- Gilead Sciences
- Bristol-Meyers-Squibb
- Henry Ford Health System
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Assessment of liver fibrosis is critical for successful individualized disease management in persons with chronic hepatitis B (CHB) or chronic hepatitis C (CHC). We expanded and validated serum marker indices to provide accurate, reproducible and easily applied methods of fibrosis assessment. Liver biopsy results from over 284 CHB and 2304 CHC patients in the Chronic Hepatitis Cohort Study (CHeCS') were mapped to a F0-F4 equivalent scale. APRI and FIB-4 scores within a 6-month window of biopsy were mapped to the same scale. A novel algorithm was applied to derive and validate optimal cut-offs for differentiating fibrosis levels. For the prediction of advanced fibrosis and cirrhosis, the FIB-4 score outperformed the other serum marker indices in the CHC cohort and was similar to APRI in the CHB cohort. The area under the receiver operating characteristic curves (AUROC) for FIB-4 in differentiating F3-F4 from F0-F2 was 0.86 (95% CI: 0.80-0.92) for CHB and 0.83 (95% CI: 0.81-0.85) for CHC. The suggested cut-offs based on FIB-4 model produced high positive predictive values [CHB: 90.0% for F0-F2, 100.0% for cirrhosis (F4); CHC: 89.7% for F0-F2; 82.9% for cirrhosis (F4)]. In this large observational cohort, FIB-4 predicted the upper and lower end of liver fibrosis stage (cirrhosis and F0-F2, respectively) with a high degree of accuracy in both CHB and CHC patients.
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